House Speaker Nancy Pelosi held a large gavel as she emerged from a Democratic Caucus meeting with (from left) Reps. Steny Hoyer of Maryland, John Lewis of Georgia, and Jim Clyburn of South Carolina in late March.

Lauren Victoria Burke/AP

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Thomas D’Alesandro Jr., Nancy Pelosi’s father and the former mayor of Baltimore, talked with President John Kennedy in 1961 at the White
House while a young Nancy (l.) and her mother, Annunciata, looked on.

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Nancy Pelosi acknowledged supporters at her headquarters in San Francisco on April 7, 1987, the night she won a special election en route to her first job in Congress – as the representative from California’s Eighth Congressional District, covering San Francisco.

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Nancy Pelosi and her husband, Paul, a San Francisco financier and businessman, enjoyed a moment after a Democratic victory celebration in Washington on Nov. 8, 2006.

Gerald Herbert/AP

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Speaker Nancy Pelosi conferred with Senate majority leader Harry Reid (left) and other congressional members after Mr. Obama signed a jobs initiative in the Rose Garden March 18.

Jason Reed/Reuters

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President Obama raised the arm of Speaker Nancy Pelosi at a Democratic congressional fundraising dinner in New York in early May. Ms. Pelosi is a virtual ATM for Democrats, having raised $162 million for candidates since 2002.

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Nancy Pelosi spoke about health-care reform at a news conference on Capitol Hill on March 4, 2010.

Washington — Nancy Pelosi's office is all cream and gold, marble mantels and gilt mirrors, with that classic sight line straight down the Mall past the Washington Monument to the Lincoln Memorial. Instead of the smoke-filled rooms of House speakers past, the scent of lilies drifts out into the hall. The deep-red paint of Republican years in power was chipped off the walls of the corridor outside the office on Ms. Pelosi's watch, exposing an original 1901 mural – a classical maiden clasping a sheaf of wheat who, in Pompeian style, appears to be floating in air, with no visible means of support.

There's an art to being Nancy Pelosi. Visitors walking into her office with a can of soda are offered a glass. There's no Big Desk in the room that says power. It's not needed. Guests are directed to a chair facing the Mall. Her chair, framed by the most privileged view in Washington, is also positioned so she can follow House floor action on four small TVs off to the side, without looking distracted. In what may be an unintended consequence, the horizontal, late afternoon light gives her face a halo glow, and leaves guests squinting.

What stuns many visitors to the office, including House Democrats, are the personal details that she knows about them. Pelosi exudes an ease and grace in one-on-one meetings that doesn't show up on television or before crowds. At times, she comes off like a (stylish) grandmother tending the lost boys. "I'll use my mother-of-five voice," or, "It's my grandmother-of-eight look," she'll say. Her daily chocolate-ice-cream fix is another convivial touch, reinforced by Ghirardelli chocolate squares just a reach away.

But make no mistake: Nancy Pelosi is the most powerful woman in American politics and the most powerful House speaker since Sam Rayburn a half century ago. She is also one of the most partisan.

During her 3-1/2-year tenure as speaker, she has shepherded through major pieces of legislation – most notably the landmark and controversial health-care bill, for which she was responsible in the climactic hours more than is generally known – and done so in an era of partisan gridlock. To achieve that, she has shown uncommon skill in enforcing discipline in Democratic Party ranks at a time when members are more fractious and ideologically diverse than in decades.

Pelosi makes no pretext about working with Republicans, and they respond in kind. At once relentless and highly pragmatic, she has expanded the powers of the speaker's office into the day-to-day operations of the House campaign arm, the Democratic Congressional Campaign Committee, and restricted minority rights even beyond what the Republicans did in the 12 years they last controlled the House.

She has also reined in powerful committee chairmen in her own party. More so than previous speakers, she drafts major bills in the speaker's office, rather than going through a full committee process. Members cross her at their peril.

Her increasing power and the visibility of her job have made Pelosi one of the most controversial politicians in the country – and a popular target in the looming midterm elections. She is to Republicans what Sarah Palin is to Democrats, a cartoon figure whose every feature – hair, clothes, makeup, body parts – are fair game for satire and speculation.

It's criticism she has heard throughout her public life, but, like many besieged politicians, she seems to use it as fuel. "My friends, they would call me: 'Can you believe what they said?' " she says in an interview. "I said: 'Why are you calling me? Are you calling me to waste my time? If you don't like what they're saying, recruit volunteers, raise money, go door to door....' "

Pelosi isn't a Rhodes Scholar like Speaker Carl Albert (D) of Oklahoma (1971-76). She doesn't turn out rapid-fire policy ideas like Speaker Newt Gingrich (R) of Georgia (1995-98). Nor does she see herself as a "coach" like Speaker Dennis Hastert (R) of Illinois (1999-2006). On camera, she often appears awkward or stilted, especially under fire. (Faced with criticism that she knew about the Bush-era "torture" of 9/11 detainees and did nothing, she fell back on reading a statement. Pressed for clarification, she looked down and simply read it again.) But for raw organizational skills – preparation, networking, political instinct, and dogged persistence – Pelosi is in a class by herself.

"Nancy Pelosi has an exceptional political mind. She is constantly calculating the political implications of every circumstance that she encounters and what needs to happen," says Ronald Peters, a professor of political science at the University of Oklahoma who has interviewed every speaker since John McCormack (D) of Massachusetts (1961-70). "Few speakers come close to her in terms of constant organizational effort."

In a town that typically sorts people as insiders or outsiders, Pelosi is an unusual mixture of both. Most speakers historically excelled at the insider game: building up favors and relationships with colleagues, while plotting ways to move up the party ranks. Once established as speaker, they had a base to expand national contacts and outreach. By contrast, Pelosi – a lifelong Democratic fundraiser – began her freshman year in the House with her own network of national donors. Over time, she tapped these contacts to move votes on the floor.

The key to Pelosi's success is her drive and mastery of detail – the working knowledge she has of who her members are, what their districts need, and who on the outside can be mobilized to affect their votes. In short, she knows the critical "back door" to members.

It's a skill set that no previous speaker had to the same extent, because none spent the time that she has working contacts on the outside. Since entering leadership in 2002, Pelosi has raised $162 million for Democratic candidates. It's an unthinkable sum for previous speakers and shows the increasing importance of vast war chests to win and hold majorities in bitterly partisan times. With a few calls or a well-timed fundraiser, she can sweeten a tough vote or pressure a member considering an unhelpful one.

Call it the art of political cover. In an era of pure partisan gridlock, no one is doing it better.

"The arts of politics are bred in her bones: the ability to get people to like you, to build coalitions, to reach agreements," says Jack Pitney, a political scientist at Claremont McKenna College in Claremont, Calif. "It's what she grew up with, with her father and her brother. And those are the things that don't come easily to a lot of people."

In the D'Alesandro household, Democratic Party politics and family were inseparable. Pelosi and her five older brothers took turns manning the table near the front door, where constituents came for help or something to eat. "It was an unusual situation, as I look back on it, but it was the life we led," she says. "People would come and they would ask how they could get a bed in the city hospital, a place to live in housing projects, food, a job, and our family was always there to help."

Her mother, Annunciata or Nancy, kept records of all the favors asked and granted on slips of paper to use as a contact list for others needing help. These habits were reinforced by Roman Catholic social teaching, a steady influence in Pelosi's life since childhood. Her mother wanted her to become a nun. "[T]hat was not going to happen," she wrote in her 2008 autobiography, "Know Your Power: A Message to America's Daughters." Pelosi typically still attends mass at least once a week and maintains strong ties with Catholic communities. She describes church teachings as central to her life and the inspiration for "our responsibility to each other," but she also sees a role for public policy to make such promises practical.

"How many times can we answer the door or the phone and send somebody here or there?" she says. "There has to be a different way. We have to have different public policy to meet the needs of people."

Pelosi came of age in a prefeminist era. Her politics did not grow out of anger or struggle but culture and conviction. As a student at Trinity College (now Trinity Washington University), she was inspired by President Kennedy's call for service. "Because we were in Washington, daughters of Catholic politicians came here in large numbers," says Pat McGuire, president of Trinity. "The Kennedy era was a time of great political fervor and change, a point not lost on students at the nation's leading Catholic college for women."

Pelosi didn't get into the family business right away. When House majority leader Steny Hoyer, her main rival on the way up in House Democratic ranks, was elected to the Maryland State Senate in 1966, Pelosi was caring for her young family in New York City: her husband, Paul, a financier, and three babies, soon to be five children in six years.

The family moved to San Francisco in 1969 at the start of the Silicon Valley high-tech boom. For Nancy, the first step back into politics was an appointment to the San Francisco Library Commission, which needed resources. "One day they said to me: 'If only one of us knew Leo McCarthy,' who was then speaker of the [state] Assembly, and I said: 'I know Leo' ... and, of course, it took me right back to politics."

From the start, Pelosi built her own political career on finding resources to support others. With all five children in school, Pelosi began volunteering for Mr. McCarthy and raising funds for local candidates out of her San Francisco home near the Presidio. She told the kids: "Proper preparation prevents poor performance," a motto that covered her approach to fundraising and political organizing.

In 1976, Pelosi wrote a memo to California Gov. Jerry Brown (D), a former classmate of her husband's, urging him to get into the Maryland presidential primary. She volunteered her help and family connections. He accepted. In a surprise move, Mr. Brown won Maryland and in return backed Pelosi to chair the Northern California Democratic Party and, later, the state party.

What impressed the Democratic political establishment was her energy, organizational and fundraising skills, and network of personal connections. She set up the first permanent party headquarters and moved a paper-and-pencil operation into the computer era. In 1984, she helped bring the Democratic National Convention to San Francisco. Perhaps most important, she developed a reputation for delivering what she promised.

In an era of hard-talking party bosses, it was easy to dismiss the charming Pacific Heights mother of five as a lightweight. "Everyone underestimates her from Day 1," says Roz Wyman, a close friend who chaired the 1984 Convention. "Nancy is quite remarkable, and it's only now, since the health-care vote came up, that people realize what she does."

For Pelosi, fundraising wasn't just a process, loathed by most politicians, of getting cash to candidates. It was also a path to vital political information: what donors care about, what motivates them, and how to convert those motivations into a check for Democrats. Over time her California contacts helped fund campaigns across the nation.

But when Pelosi attempted a run for chairman of the Democratic National Committee in 1984-85, she was dismissed by some in the East Coast old guard as "an airhead" – a rich San Francisco liberal who could give parties, but what else? After setting up an office in Washington to campaign for the job, Pelosi dropped out a day before the vote, convinced that she couldn't win. But the experience marked her. "I always said that if I hadn't run for chair of the DNC I might not have realized how rough the intramural game can be on the Democratic side," she says.

Undaunted, she helped Democrats take back the Senate in 1986, as chair of the Finance Committee of the Democratic Senatorial Campaign Committee. The effort earned her not just favors but an encyclopedic grasp of key outside players in politics and what their needs were, which would become an essential resource as speaker. "People talk about her enormous fundraising prowess, but it's because she understood the value of relationships," says Cecile Richards, president of Planned Parenthood and a former Pelosi deputy chief of staff. "She has built loyal relationships across this country, and people would walk across hot coals for her."

At the age of 47, Pelosi had raised five children, moved in the top echelons of party politics, and turned receptions in her San Francisco home into an ATM for Democrats. What she had not done was be elected to public office. That was about to change.

For California Democrats aiming for a career in politics, there were plenty of crusades to join: Berkeley's free-speech movement, early environmentalism, civil rights, peace, gay rights. But contrary to her image as a San Francisco liberal, Pelosi was never an issue activist. Unlike Sen. Barbara Boxer (D) of California, a friend, Pelosi never subscribed to a movement beyond the Democratic Party.

"Her passion was always the Democratic Party as opposed to these issues one at a time, because she believed that the Democratic Party embraced these issues," says Senator Boxer.

Over time Pelosi mastered a diversity of relationships unusual even in politics, from traditional trade union bosses to the ethnic and gay communities that were transforming her adopted city. Her unlikely relationship with US Rep. Phillip Burton (D) of California was decisive in launching her own political career. A fiery liberal and master of the inside game, Mr. Burton came within one vote of being House majority leader in 1976.

Although he pilloried the rich, Burton valued Pelosi for her political street sense and ability to get things done. At first glance, the two had little in common. They moved in rigidly separate social circles. Burton was loud, crude, and drank heavily – a wild man, critics said. Pelosi was none of those things. Yet both shared an attention to detail and an uncommonly fine tactical sense. At his death, Burton was succeeded in California's Eighth District by his wife, Sala, who during her last illness urged Pelosi to run to take her place.

"I never planned ... to go from the kitchen to the Congress," recalls Pelosi. Sala, she says, "almost demanded that I promise her that I would run for Congress if she did not."

Running on the theme "A voice that will be heard," Pelosi spent more than $1 million on the 1987 special election to fill Burton's seat – more than all the other candidates combined.

In a body of 435 members, most House freshmen take years to be heard. But with her network of favors both to the California delegation and Democrats nationwide, Pelosi was not the average apprentice. She used her network to begin to conquer the House Democratic caucus, one relationship at a time.

She landed a seat on the powerful House Appropriations Committee. In Washington, she began to host a weekly dinner group for liberal Democrats. At home in San Francisco, she expanded fundraisers to help both Democratic incumbents and challengers. The loss of control of the House in the 1994 elections stunned Democrats, none of whom had experienced life in the minority, and gave Pelosi a shot at leadership.

"I only decided to run when we lost the House. We lost it and then we lost again, and then we lost it again," she says. "Around 2000 I said: 'You know what? I know how to win. I can do this.' "

It helped that Pelosi had two growing power bases on which to build her ascent to power. One was the California delegation, the largest in the House; the other, women. When Pelosi first came to the House, 23 women served in the chamber. When she defeated Mr. Hoyer for whip in October 2001, there were 62. Today, there are 76.

Rep. Rush Holt (D) of New Jersey recalls giving Pelosi an early commitment to vote for her in the whip race against Hoyer. Soon after, he got calls from key constituents making sure he was going to keep his pledge. "She knew just who to have call me from back home – people I would listen to," he says.

When House Democratic leader Dick Gephardt stepped down after yet another disappointing midterm election for Democrats in 2002, Pelosi was elected by the caucus to take his place.

For four years as leader of the Democratic minority, Pelosi urged her caucus to oppose the majority at every point and force Republicans to come up with the tough votes on their own. Unlike Mr. Gephardt, Pelosi pushed for strict party loyalty. Every Democrat who voted with the Republicans gave a GOP moderate, especially those in swing districts, a pass, she said. With that game plan, Pelosi led Democrats to their highest party unity scores since Congressional Quarterly began keeping track in 1953, despite their deep divide over the Iraq war.

In the 2006 midterm elections, she framed a national campaign attacking the GOP for presiding over a "culture of corruption." Democrats picked up 31 seats – 20 from districts that had voted for George W. Bush in 2004 – and retook control of the House. On Jan. 4, 2007, grandchildren at her side, Pelosi was sworn in as the first woman speaker, the highest office attained by a woman in US politics.

Even though House Democrats picked up another 21 seats in the 2008 elections, expanding their majority to 257 to 178, many of these new members came from moderate to conservative districts. Pelosi dubbed them her "majority makers."

But the new "big tent" majority posed a formidable management challenge. Many of the newcomers from previously held GOP seats had won their elections railing against big government, deficit spending, and taxes. Some called for more limits on abortion rights and defended gun rights.

They often found themselves at odds with the Democratic majority they helped to create. Pelosi listened. When possible, she compromised. When necessary, she mobilized outside groups to help persuade. But the outreach did not extend to minority Republicans, who were feeling increasingly alienated – and hostile.

"There has not been a glimmer of bipartisanship," says Michael Steel, a spokesman for Republican leader John Boehner of Ohio. "It's one thing to not include Republican ideas in the legislation, but Republicans aren't even allowed to present amendments to improve the legislation."

Nowhere would Pelosi's skills at finding unexpected resources to swing votes be more challenged than over health-care reform.

Even before she took over as Speaker, Pelosi had maintained close relations with Catholic women's religious organizations. They shared not only the same faith but often also the same politics. Catholic activists would meet at least weekly with members of her office. They worked together on issues such as support for the uninsured, child nutrition, immigration, and expanding health coverage for poor children. Those ties were about to become pivotal.

After a year of intense White House negotiations and legislative wrangling, health-care reform was foundering. House and Senate versions of the bill were far apart, and an upset by Republican Scott Brown in the Jan. 19 Massachusetts special election dropped Democrats below the 60 votes they needed to block a GOP filibuster in the Senate.

At the White House, the mood had turned to scaling back expectations. White House Chief of Staff Rahm Emanuel urged an incremental approach to break up the health-care bill and pass only those elements that could clear the Senate. But Pelosi, alone among top congressional leaders, balked. She would not accept health-care lite, she told the White House. "It's like the teensy-weensy spider," she said.

The plan subsequently worked out with the White House and Democratic leaders was this: Pass the Senate version of health-care reform in the House, along with a package of "fixes" that the Senate would commit to passing, under procedures requiring only a majority vote. With most of her caucus opposed to the Senate bill in its current form, Pelosi insisted on getting a commitment from the Senate on passing the fixes in writing. But first, Pelosi had to win a tough vote in her chamber.

She settled in for weeks of earlier mornings and later nights spent meeting with elements of her caucus: New Democrats, Blue Dogs, progressives, the Congressional Black Caucus, the Hispanic Caucus, vulnerable freshman and sophomores, as well as regional interests. She didn't expect GOP votes and invested no time looking for them. Step by step, she fielded the leading concerns members had with the Senate bill and what "fixes" could resolve them.

A week before the vote, it had all come down to a fierce, intraparty dispute over language limiting federal funding of abortion. Rep. Bart Stupak, an anti-abortion Democrat from Michigan, publicly backed by the US Conference of Catholic Bishops, said he and at least 40 of his supporters would vote down a Senate bill that did not contain the stronger House language blocking public abortion funding.

In response, 40 abortion-rights Democrats, led by Rep. Diana DeGette of Colorado, signed a letter pledging to vote down any legislation that further restricted a woman's right to choose. For the speaker, it appeared to be a cul-de-sac.

Enter the nuns. In a decisive move, Sister Carol Keehan, president and CEO of the Catholic Health Association, and Sister Simone Campbell, representing NETWORK, a social-justice lobby for Catholic churchwomen, said publicly that the Senate language did not, in fact, expand federal funding for abortion and announced their support of the Senate bill – a rare public break with the bishops. "Our contacts there [in Pelosi's office] helped us know the rhythm and concerns of the speaker's office," Sister Campbell says. "We knew where the votes were or weren't. It's not rocket science. Key Catholic votes were needed – and [these members] needed assurance that this new abortion mechanism would work."

Mr. Stupak was stunned. "We had never heard of these nuns before," he says.

At the climactic hour, Pelosi offered Stupak and other holdouts a sweetener: The White House would issue an executive order clarifying that public funds would not be used to fund abortion. This agreement, as well as the public backing of the Catholic churchwomen, gave anti-abortion Democrats cover for backing the Senate bill – and gave Pelosi her last critical votes for passing the Senate health-care bill. "Three or four in the Stupak coalition went over to the other side explicitly saying they [were] moved by the nuns...," says Deal Hudson, president of the Catholic Advocate, an anti-abortion advocacy group. "So it was a very powerful move at that moment in time."

On the other side, abortion-rights groups swallowed an executive order they found repellent because they trusted her assurances that this course was the only way to get a bill. "Without Pelosi, this bill would not have passed," says Congresswoman DeGette.

In the end, the maneuvering on the abortion roadblock and the entire health-care issue was vintage Pelosi: It demonstrated a mastery of the legislative process, an instinct for providing vulnerable members adequate political cover – and no rapprochement with Republicans.

On a warm spring night, many Democratic Party activists at the annual Midland County Democratic Smorgasbord in Industry, Pa., arrive at the same time, straight from Saturday evening mass. Despite hard economic times, cultural issues – church and family, gun rights, education, opposition to abortion – count here in western Pennsylvania's old industrial heartland, along the Ohio River, and the image of Pelosi as San Francisco liberal doesn't sit well, even among many party regulars.

"She fails to represent what I believe in," says Terry Colatriano, a former steelworker. "Obviously she thinks she's the face of the Democratic Party. She's too far left."

Others say they don't like her because she has a phony grin, can't be trusted, plays a game too big for her, or likes the spotlight too much.

Howard McDonald, a retired railroad worker and lifelong Democrat sitting at the next table, quietly dissents. "People don't like her because she's strong," he says. "She's a tough chick."

The unequivocal views show how visible Pelosi is outside the marbled halls of Washington – and how big of an issue she will be in the midterm elections. The congresswoman remains a target across the country like few speakers before her. That's in part because she's serving in highly polarized times. It may also stem from her gender and almost certainly is rooted in the caricature of her, conveyed incessantly in the conservative blogosphere and in cable-TV land, as a vacuous yet somehow omnipotent San Francisco lefty.

Health care is a factor, too. Next to President Obama, no one is as identified with the passage of the legislation more than Pelosi, and its reception on Main Street will help decide the Democrats' fate.

"The first woman speaker is always going to have a higher profile, but she sought out an even higher profile, and it's not been helpful to the party," says Charlie Cook of the Cook Political Report, who predicts there's at least a 50-50 chance the Democrats will not retain their majority.

In national polls, only 36 percent of Americans hold a favorable view of Pelosi – nearly as low as one other lightning-rod speaker, Mr. Gingrich, who bottomed out at 25 percent approval rating in March 1997.

It's one reason the National Republican Congressional Committee is blitzing the 2010 House campaign with anti-Pelosi ads. "That's the narrative for congressional races across the country," says NRCC spokesman Tory Mazzola. "We have a picture of [Rep.] Kathy Dahlkemper [(D) of Pennsylvania] standing right behind Nancy Pelosi when they unveiled the health-care bill, and we want to make sure voters see that before they make up their minds."

Yet Republicans will have to do more than demonize Pelosi to recapture Congress. In the May 18 special election in southwest Pennsylvania, Republican businessman Tim Burns targeted the speaker, too. "I think I'm really looking forward to telling Nancy Pelosi to her face what I think of her," he told retired coal miners with some brio at the College Town Diner in Waynesburg, Pa. National GOP groups piled on with anti-Pelosi ads. Mr. Burns lost to Democrat Mark Critz by eight points.

Pelosi still has a formidable capacity to raise funds for party members. She has collected $28.7 million for the Democratic Congressional Campaign Committee in the current election cycle, compared with $12 million cash on hand for the NRCC. She travels widely, but selectively.

Maybe so. But there's a reason most speakers have chosen to keep a lower profile. It is, after all, the "Peoples' House." Members must fit their districts, and that's complicated by a highly visible speaker who doesn't.

Pelosi insists that Democrats will be in the majority after the midterm elections. Should Democrats lose their majority – or enough seats to spark a caucus coup – she could go the way of Gingrich, who started his speakership as Time magazine Man of the Year and resigned four years later, after Republicans lost five seats in the 1998 elections.

Either way, this fall will likely mean change for Pelosi. If Democrats must govern with a smaller majority, it could mean asking conservatives and moderates to take more tough votes for the team or reaching out to Republicans.

Like the maiden floating in the mural at the entrance to her office, she may continue a career-long capacity to rally support not visible to others. Or that sheaf the maiden carries might have to become an olive branch, proffered to the opposition.